Regional Anesthesia and Postoperative Opioid Use in Autologous Breast Reconstruction: A Systematic Review and Meta-analysis.

Background: Nerve and fascial plane blocks are common components of early recovery after surgery protocols for autologous breast reconstruction, but there is mixed data regarding their efficacy. This study evaluated the association between regional anesthesia and postoperative opioid use, patient-reported pain, length of stay (LOS), and duration of surgery.

Methods: We conducted a systematic review of articles on regional anesthesia in autologous breast reconstruction and a dual extraction of outcomes. Data of interest included total, 24-hour, and 48-hour opioid use (intravenous [IV] morphine milligram equivalents [MMEs]), patient-reported pain, and length of surgery and stay. We performed meta-analyses with random effects models for mean difference (MD).

Results: We included 21 studies for analysis. Total opioid use was reduced among patients who received regional anesthesia (MD = -10.28 IV MMEs, ~3 oxycodone 5-mg equivalents, P < 0.05), as was opioid use at 24 (MD = -21.65 IV MMEs, P < 0.05) and 48 hours (MD = -24.42, P < 0.05). However, total opioid use was not significantly different when considering only data from randomized trials. There was no significant reduction in patient-reported pain at 48 hours (standardized MD = -0.28), nor was there a significant reduction in the length of surgery (MD = -0.26 h). Regional anesthesia was associated with an average 0.73-day reduced LOS.

Conclusions: Regional anesthesia was associated with a statistically but not clinically significant reduction in total postoperative opioid use and LOS following autologous breast reconstruction. Total opioid use was not significantly different when considering only randomized controlled trial data.